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Acute promyelocytic leukemia: morphological aspects

G L Castoldi1, V Liso, G Specchia

  • 1Institute of Hematology, University of Ferrara, Italy.

Leukemia
|January 1, 1994
PubMed
Summary

Acute promyelocytic leukemia (APL) is a distinct subtype of AML with maturation, presenting with varied cytological features. Accurate diagnosis relies on cytochemistry, cytogenetics, and electron microscopy for differentiation.

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Area of Science:

  • Hematology
  • Oncology
  • Cell Biology

Background:

  • Acute promyelocytic leukemia (APL) is a specific subtype of acute myeloid leukemia (AML) with maturation, comprising 5-10% of FAB variants.
  • APL exhibits diverse cytological presentations, including hypergranular, microgranular, and hyperbasophilic forms.
  • These morphological variations can mimic other hematologic malignancies, necessitating precise diagnostic approaches.

Purpose of the Study:

  • To delineate the distinct cytological and cytochemical characteristics of APL subtypes.
  • To highlight the diagnostic challenges and differential diagnosis considerations for APL.
  • To emphasize the role of ancillary techniques in confirming APL diagnosis.

Main Methods:

  • Morphological examination of peripheral blood and bone marrow smears.
  • Cytochemical staining, including myeloperoxidase, Sudan black B, chloroacetate esterase, and non-specific esterase.
  • Cytogenetic investigations and electron microscopy for challenging cases.

Main Results:

  • Hypergranular APL shows abundant granules; microgranular APL has fine or absent granulation and bilobed nuclei; hyperbasophilic APL exhibits high N/C ratio and budding.
  • Typical APL (M3) demonstrates strong positivity for myeloperoxidase, Sudan black B, and chloroacetate esterase, with weaker reactivity in M3v.
  • Cytochemical heterogeneity and a distinct entity with basophilic differentiation were observed, requiring advanced diagnostic tools.

Conclusions:

  • APL presents with heterogeneous morphology and cytochemical profiles.
  • Distinguishing APL subtypes and ruling out mimics like M2-baso, MDS, or AML with basophilia requires a combination of morphology, cytochemistry, and advanced techniques.
  • Accurate diagnosis of APL is crucial for appropriate treatment and management.

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